Recurrent wheezing and asthma-Epidemiology and environmental determinants.

Wheeze is the musical continuous sound produced by oscillations in any critically narrowed airways, and heard mostly on expiration. It is common in preschool age, about half of all children will experience an episode of wheezing by their sixth birthday. Asthma is usually characterized by cough, wheeze, chest tightness and fast breathing. It is a significant global health issue and affects both children and adults. The prevalence is on the increase, especially in LMIC. Studies from different populations have revealed the key role influencing the progression from preschool wheezing to childhood asthma. Recurrent wheezing is four or more episodes in the preceding year and has a spectrum of phenotypes and with heterogeneous features. Phenotypes of wheezing were proposed to facilitate the identification of young children who are at risk of subsequent development of asthma. The epidemiology and environmental determinants of recurrent wheezing and asthma are discussed.

Complications and long-term impact of early life pneumonia.

Pneumonia is an infection affecting the lower airway, where the air sacs are filled with mucus and pus; and typically presents with cough, fever, and fast breathing. Pneumonia is estimated to be the leading cause of mortality in children under five worldwide with 120 million episodes result in 1 million deaths globally. The Low-Income and Middle-Income Countries (LMICs) are more affected. In a study in southeast Nigeria, bronchopneumonia accounted for 41.9%, of the cases admitted in the tertiary hospitals and in another hospital based study among children, pneumonia had the highest respiratory admission rates at 34.0%. Pneumonia can be caused by various organisms: Bacterial (Streptococcus, staphylococcus etc), Viral (RSV) and recently COVID 19 pneumonia. RSV has been noted globally to be a major cause of childhood lower respiratory tract infection, with morbidity/mortality occurring in 99% of (LMICs). Some of the long term sequalae are discussed.

Health-related quality of life in asthma measured by the World Health Organization brief questionnaire (WHO-BREF) and the effect of concomitant allergic rhinitis-A population-based study.

BACKGROUND AND OBJECTIVE: The impact of allergic rhinitis (AR), a common comorbidity in asthma, on global quality of life (QoL) using generic QoL questionnaires has not been extensively evaluated. METHODS: This was a cross-sectional population-based study among adults ≥18 years old. Generic QoL was measured using the World Health Organization (WHO) questionnaire (WHOQOL-BREF), and asthma control was assessed using the Asthma Control Test. Participants were categorized into four groups: Group 1 (No asthma, no AR), Group 2 (Asthma only), Group 3 (AR only) and Group 4 (Concomitant asthma and AR). The student t-test or the ANOVA was used for comparison between groups and based on the level of asthma control. Linear regression was used to assess the association between the level of asthma control and QoL scores, adjusted for age and sex. A p-value of less than 0.05 was considered significant for all associations. RESULTS: There were 9115 participants; 906 (9.9%) had asthma, and 1998 (21.9%) had AR. The lowest QoL scores were in the environment domain. Mean QoL scores were significantly lower in asthma compared to 'no asthma' and in AR compared to 'no AR'. Either asthma or rhinitis (Group 2 or 3) had significantly lower scores compared to no disease (Group 1) only in the environment domain, but the concomitant disease (Group 4) had lower scores across all categories and domains. Scores were significantly lower for uncontrolled asthma compared to controlled asthma and for 'concomitant asthma and AR' compared to 'asthma only'. Increasing age and uncontrolled asthma predicted worse health-related quality of life (HRQoL) consistently. CONCLUSION: Although asthma and AR negatively impact HRQoL independently, concomitant asthma and AR are worse. Uncontrolled asthma underpins poor QoL in asthma because QoL is not impaired in controlled disease. This underscores the need for recognition and treatment of AR in asthma and reinforces the benefits of achieving asthma control as a priority in asthma treatment.

Factors associated with common mental disorders among breastfeeding mothers in tertiary hospital nurseries in Nigeria.

BACKGROUND: Several studies have shown that the impact of maternal mental health disorders on newborns' well-being in low and middle-income countries (LMIC) are underreported, multi-dimensional and varies over time and differs from what is reported in high-income countries. We present the prevalence and risk factors associated with common mental disorders (CMDs) among breastfeeding mothers whose infants were admitted to Nigerian tertiary care facilities. METHODS: This was a national cross-sectional study involving mothers of hospitalised babies from eleven Nigerian tertiary hospitals. We used the WHO self-reporting Questionnaire 20 and an adapted WHO/UNICEF ten-step breastfeeding support package to assess mothers' mental health and breastfeeding support. RESULTS: Only 895 of the 1,120 mothers recruited from eleven tertiary healthcare nurseries in six geopolitical zones of Nigeria had complete datasets for analysis. The participants' mean age was 29.9 ± 6.2 years. One in four had CMDs; 24.0% (95% CI: 21.235, 26.937%). The ages of mothers, parity, gestational age at delivery, and length of hospital stay were comparable between mothers with and those without CMDs. Antenatal care at primary healthcare facilities (adjusted odds ratio [aOR:13], primary education [aOR:3.255] living in the south-southern region of the country [aOR 2.207], poor breastfeeding support [aOR:1.467], polygamous family settings [aOR:2.182], and a previous history of mental health disorders [aOR:4.684] were significantly associated with CMDs. In contrast, those from the middle and lower socioeconomic classes were less likely to develop CMDs, with [aOR:0.532] and [aOR:0.493], respectively. CONCLUSION: In Nigeria, the prevalence of CMDs is relatively high among breastfeeding mothers with infants admitted to a tertiary care facility. Prior history of mental illness, polygamous households, mothers living in the southern region and low or no educational attainment have a greater risk of developing CMDs. This study provides evidence for assessing and tailoring interventions to CMDs among breastfeeding mothers in neonatal nurseries in LMIC.

Postnatal probiotic supplementation can prevent and optimize treatment of childhood asthma and atopic disorders: A systematic review of randomized controlled trials.

Background: Although several randomized controlled trials (RCTs) published over the past 5 years show that prenatal or postnatal probiotics may prevent or optimize the treatment of childhood asthma and atopic disorders, findings from the systematic reviews and meta-analyses of these studies appear inconsistent. More recent RCTs have focused on postnatal probiotics, and linked specific probiotic strains to better disease outcomes. Objective: This systematic review aimed to determine if postnatal probiotics are as effective as prenatal probiotics in preventing or treating childhood asthma and atopic disorders. Methods: We searched the PubMed, Medline, Google Scholar, and EMBASE databases for RCTs published within the past 5 years (from 2017 to 2022). We included only full-text RCTs on human subjects published in or translated into the English language. We retrieved relevant data items with a preconceived data-extraction form and assessed the methodological quality of the selected RCTs using the Cochrane Collaboration's tool for assessing the risk of bias in randomized trials. We qualitatively synthesized the retrieved data to determine any significant differences in study endpoints of the probiotic and placebo groups. Results: A total of 1,320 participants (688 and 632 in the probiotic and placebo groups) from six RCTs were investigated. One RCT showed that early Lactobacillus rhamnosus GG (LGG) led to a reduction in the cumulative incidence rate of asthma. Another study demonstrated that mixed strains of Lactobacillus paracasei and Lactobacillus fermentum could support clinical improvement in children with asthma while one trial reported a significant reduction in the frequency of asthma exacerbations using a mixture of Ligilactobacillus salivarius and Bifidobacterium breve. Three trials showed that a combination of LGG and Bifidobacterium animalis subsp lactis, Lactobacillus rhamnosus alone, and a probiotic mixture of Lactobacillus LOCK strains improved clinical outcomes in children with atopic dermatitis and cow-milk protein allergy. Conclusions: Postnatal strain-specific probiotics (in single or mixed forms) are beneficial in preventing and treating atopic dermatitis and other allergies. Similarly, specific strains are more effective in preventing asthma or improving asthma outcomes. We recommend more interventional studies to establish the most useful probiotic strain in these allergic diseases.

Bronchiectasis in African children: Challenges and barriers to care.

Bronchiectasis (BE) is a chronic condition affecting the bronchial tree. It is characterized by the dilatation of large and medium-sized airways, secondary to damage of the underlying bronchial wall structural elements and accompanied by the clinical picture of recurrent or persistent cough. Despite an increased awareness of childhood BE, there is still a paucity of data on the epidemiology, pathophysiological phenotypes, diagnosis, management, and outcomes in Africa where the prevalence is mostly unmeasured, and likely to be higher than high-income countries. Diagnostic pathways and management principles have largely been extrapolated from approaches in adults and children in high-income countries or from data in children with cystic fibrosis. Here we provide an overview of pediatric BE in Africa, highlighting risk factors, diagnostic and management challenges, need for a global approach to addressing key research gaps, and recommendations for practitioners working in Africa.

Small-airway disease and its reversibility in human immunodeficiency virus-infected children on highly active antiretroviral therapy: A cross-sectional study in an African setting.

BACKGROUND: Lung function abnormalities may occur in children with human immunodeficiency virus (HIV) infection. Small-airway disease (SAD) precedes abnormalities in forced expiratory volume in 1 s (FEV 1). OBJECTIVE: This study aims to assess the presence and reversibility of SAD in HIV-infected children using the Global Lung Function Initiative standards. METHODS: A cross-sectional study was conducted over 6 months at the Paediatric HIV Clinic of the University of Nigeria Teaching Hospital in Enugu, Southeast Nigeria. Eligible consenting children with HIV infection were recruited. Lung function was measured, and the reversibility of FEV1 and forced vital capacity (FVC) was assessed at 12% while that of forced expiratory flow between 25% and 75% (FEF25-75) was assessed at 12%, 15%, and 20%. Predictors of abnormal Z-score values were determined by multivariate linear and logistic regressions. Statistically significant values were set at P < 0.05. RESULTS: The mean Z-score for FEV1, FVC, and FEF25-75 was - 2.19, -1.86, and - 1.60, respectively. Most patients (73%) had abnormal FEV1, while 52% had abnormal FEF25-75. Significant changes in FEV1 (P = 0.001) and FEF25-75 (P < 0.001) occurred after the bronchodilator response (BDR) test. Of the children whose FEV1 showed positive BDR, 70.9% had low zFEV1; 50% had low zFEF25-75, while all had low FEV1. Nutritional status (Z-score for body mass index) was significantly associated with low FEV1. CONCLUSIONS: Abnormal FEF25-75 as a marker of SAD and FEV1 with a positive BDR are common in HIV-infected children. These lung function abnormalities justify long-term follow-up for these patients.

Spirometry Abnormalities and Its Associated Factors Among Primary School Children in a Nigerian City.

BACKGROUND: There is paucity of data on objectively measured lung function abnormalities in Nigerian children using diagnostic testing methods such as spirometry. Such assessments could prompt early diagnosis and therapeutic interventions. METHODS: This was a cross sectional study among children aged 6 to 12 years in South-Eastern Nigeria. We selected participants from one school using a multistage stratified random sampling technique. A structured respiratory questionnaire was administered to obtain necessary data. The lung functions of the children were measured by spirometry. We used Lower Limits of Normal (LLN) based on GLI reference equations for African-American and mixed ethnicities to define abnormal spirometry. We studied the association between the exposures and lung function using logistic regression/chi-squared tests. RESULTS: A total of 145 children performed acceptable and repeatable tests. There were 73 males (50.3%), mean age of 9.13 years (+1.5) and age range 6 to 12 years. Frequency of respiratory symptoms was cough- 64 (44.1%) and wheeze in 19 (13.1%). Using GLI for African-Americans, fifty-five (37.9%) children had abnormal spirometryobstructive pattern in 40 (27.6%) and restrictive pattern in 15 (10.3%). The two references showed significant differences in interpretation of abnormality (χ2 = 72.86; P < .001). Respiratory symptom-wheeze was an independent determinant of abnormal lung function in this population.(OR = 0.31; 95%CI: 0.10-0.94; P = .04). CONCLUSION: There is a high burden of respiratory symptoms and abnormal spirometry among these children. The need for objective evaluation of lung function especially for children with respiratory symptoms is evident.

Economic burden of childhood asthma in children attending a follow-up clinic in a resource-poor setting of Southeast Nigeria.

BACKGROUND: Beyond its chronicity, childhood asthma carries an economic burden for households. In this study we evaluated the cost of care of childhood asthma in a Nigerian household. METHODS: A cross-sectional hospital-based study. Relevant information was obtained through an interviewer-administered questionnaire. The cost of asthma treatment was estimated using direct medical costs and loss in productivity. Data analysis was done with SPSS version 22. A significant value of p < 0.05 was used. RESULTS: Sixty-six participants were enrolled, mean ±â€¯SD age (11.6 ±â€¯) the average direct cost was USD10.35. The cost of drug was USD5.8 and accounted for 56% of the direct cost. The loss in productivity was USD16.73. The mean cost per clinic visit was USD27.08, which was catastrophic in 12 (18.2%) households. The calculated annual cost of asthma treatment was USD162.49, with a cumulative national cost of USD 0.16 billion, which makes up 0.002% of the national GDP. CONCLUSION: The cost burden of asthma treatment may be low on the households but carries a huge national cost impact. We recommend the inclusion of asthma care in the Nigerian social health insurance as this may help reduce the financial burden due to asthma.

A short course of oral ranitidine as a novel treatment for toddler's diarrhea: a parallel-group randomized controlled trial.

BACKGROUND: The current paradigm for treating toddler's diarrhea comprises dietary modification and fluid restriction. Previous studies show that probiotics and proton-pump inhibitors (PPIs) or H2 blockers could control diarrhea associated with functional gastrointestinal disorders (FGIDs). This study aims to determine and compare the efficacy of a short course of oral ranitidine and a probiotic in the treatment of toddler's diarrhea. METHODS: This study was a parallel-group randomized controlled trial (RCT). We sequentially enrolled 40 patients who met the eligibility criteria. We randomly assigned 20 patients to the oral ranitidine group, ten patients to the probiotic group, and ten patients to the placebo group. In the oral ranitidine group, patients received oral ranitidine (3 mg/kg/day) once daily for 10 days; in the probiotic and placebo groups, they were administered 5 to 10 billion colony-forming units (CFUs) per day of lyophilized Lactobacillus rhamnosus and 50 mg of once-daily oral vitamin C tablet respectively for 10 days. Stool frequency and consistency on the 10th day of the interventions were recorded as the primary outcomes. We used the Student's t-test to determine if there were significant differences in the mean daily stool frequencies in the three intervention groups. A p-value < 0.05 was adopted as the level of statistical significance. RESULTS: In the ranitidine group, stool frequency decreased significantly from an average of five per day on the first day to an average of approximately one per day on the 10th day of intervention (t = 10.462, p <  0.001). Additionally, stool consistency normalized on the 10th day of intervention. In the probiotic group, there was a significant reduction in stool frequency from an average of five per day on the first day to four per day on the 10th day (t = 2.586, p = 0.041), although stool consistency remained loose. However, stool consistency and frequency were not significantly affected in the placebo group (t = 1.964, p = 0.072). CONCLUSION: Oral ranitidine is more effective than probiotics in reducing stool frequency and normalizing stool consistency in toddler's diarrhea. We recommend multi-center trials with appropriate study designs to confirm and validate this finding. TRIAL REGISTRATION: ISRCTN, ISRCTN10783996 . Registered 8 April 2016-Registered retrospectively.

Pre-Transition Readiness in Adolescents and Young Adults with Four Chronic Medical Conditions in South East Nigeria - An African Perspective to Adolescent Transition.

INTRODUCTION: When a child reaches a certain age, he or she moves over to the adult physician. For this to maximally benefit the child, there has to be a process of equipping the child with skills required for taking on more responsibilities. Transitioning involves a process in which the adolescent with chronic illness is prepared ahead of time to enable them to eventually transfer to adult care with good outcomes. In high-income countries with well-organized health financing, the transitioning process begins as early as 12 years. In Africa, this process is not as organized and most hospitals would write a referral letter once the child turns 18 and transfer to adult clinic. In four of our chronic disease clinics (asthma, HIV, sickle cell anaemia and chronic kidney diseases) patients up to 24 years old are still attending the paediatric clinics. Understanding transition readiness among African adolescents remains a gap. Our findings will form a basis for informed practices for adolescent clinics in African countries. METHODS: This was a descriptive cross-sectional study of pre-transition readiness in adolescents and young adults with chronic illnesses attending four outpatient specialist clinics in a tertiary hospital in Enugu Nigeria. This was done using the validated STARx Questionnaire. Total scores were computed and scores nearer the upper limit of 90 were acceptable, while mean subdomain scores of 4 and above were considered as optimal level of transition readiness. Demographic and clinical data were also collected. Acceptability to move on to adult-oriented care was documented using binary response (yes/no). Cross tabulations were done, and likelihood ratios obtained for predictors of acceptability of transition. Significant value was set at p-value of ≤0.05. RESULTS: A total of 142 adolescents and young adults aged 12 to 24 years were studied. There were 38.0% (54), 24.6% (35), 22.5% (32) and 14.8% (21) from HIV, sickle cell anaemia, asthma and nephrology clinics, respectively. Their mean age was 15.6 years ± 2.4, and 48.6% (69) were male. The mean total transition readiness score was 56±14 and this was not nearer the higher spectrum of total scores obtainable. Highest mean scores (3.7) occurred in the knowledge subdomain while least mean score (2) was noted in the use of medication reminders. The males had highest scores in the knowledge subdomain while the females were better informed about medication adherence and were more inquisitive about their chronic illness. Only about 37% (53) of the adolescents and young adults welcomed the idea of moving on to adult-care clinics. Children who had less frequent emergency hospital visits and better treatment outcome accepted the idea of transfer to adult care. Irrespective of the age all participants had suboptimal subdomain scores. High scores did not influence the participants' choice to embrace transfer to adult care. CONCLUSION: There is suboptimal transition readiness irrespective of the age. The older age groups were less willing to transfer to adult care. Better disease knowledge and better communication skills did not positively influence acceptability of transfer to adult care.

The prevalence of asthma and allergic rhinitis in Nigeria: A nationwide survey among children, adolescents and adults.

PURPOSE: Asthma is an important cause of morbidity and mortality worldwide and information on the prevalence of asthma in Nigeria is inconsistent. Nationally representative data, important for health planning is unavailable. We aimed to determine the current prevalence of asthma and allergic rhinitis in Nigeria. MATERIALS AND METHODS: A cross-sectional population survey conducted between June 2017 and March 2018 across five cities representing five geo-political zones in Nigeria. Validated screening questionnaires were used to identify persons with asthma and allergic rhinitis respectively. Asthma was defined as physician diagnosed asthma, clinical asthma and by presence of wheeze in the last 12 months respectively. Socio-demographic information, tobacco smoking, sources of household cooking fuel were also obtained. RESULTS: A total of 20063 participants from 6024 households were screened. The prevalence (95% confidence interval) of physician diagnosed asthma, clinical asthma and wheeze was 2.5% (2.3-2.7%), 6.4% (6.0-6.64%) and 9.0% (8.6-9.4%) respectively. The prevalence of allergic rhinitis was 22.8% (22.2-23.4%). The prevalence of asthma and rhinitis increased with age (prevalence of clinical asthma: 3.1% (2.8-3.4%), 9.8% (9.1-10.5) and 10.7% (9.4%-12.0) among 6-17 years, 18-45 years and >45 years respectively). Prevalence also varied across different cities with the highest prevalence of clinical asthma occurring in Lagos (8.0%) and the lowest in Ilorin (1.1%). The frequency of allergic rhinitis among persons with clinical asthma was 74.7%. Presence of allergic rhinitis, family history of asthma, current smoking and being overweight were independent determinants of current asthma among adults. CONCLUSION: The prevalence of asthma and allergic rhinitis in Nigeria is high with variabilities across regions and age groups. The number of persons with clinical asthma in Nigeria (approximately 13 million) is likely to rank among the highest in Africa. This warrants prioritization by stakeholders and policy makers to actively implement risk reduction measures and increase investment in capacity building for the diagnosis and treatment of asthma and allergic rhinitis.

Asthma management and control in Nigeria: the asthma insight and reality Nigeria (AIRNIG) study.

Background: The state of asthma management and asthma control at the population level in Nigeria is unknown. We aimed to determine the level of asthma control and asthma management practices in Nigeria. Methods: A cross-sectional population-based study of 405 participants with current asthma (physician-diagnosed with use of asthma medication or asthma symptoms in the preceding 12 months). We determined the level of asthma control, self-perception of asthma control, health-care use, missed work/school, and medication use. Results: Asthma was controlled in 6.2% of the participants. Night-time awakening and limitation in activity in the preceding 4 weeks were reported by 77.5% and 78.3%, respectively, 56.3% and 14.1% missed work/school and had emergency room visits, respectively, and 11.6% and 38.8% used inhaled corticosteroid and short-acting beta-2 agonist, respectively, in the preceding year. About a third (34.3%) had spirometry ever performed and 46.7% had training on inhaler technique. Nearly 90% with uncontrolled asthma had self-perception of asthma control between somewhat and completely controlled. Conclusion: The level of asthma control in Nigeria is poor with a high burden of asthma symptoms and limitation in activities. This calls for a broad-based approach for the improvement in asthma care that encompasses education and access to medications.

Vaso-occlusive crisis in sickle cell disease: current paradigm on pain management.

This narrative review aims to highlight the current paradigm on pain management in sickle cell vaso-occlusive crisis. It specifically examines the pathophysiologic mechanisms of sickle cell pain as well as the pharmacologic and nonpharmacologic methods of pain management. Recurrent painful episodes constitute the major morbidity in sickle cell disease (SCD). While adolescents and young adults experience mostly acute episodic nociceptive pain, it is now recognized that a significant number of adult patients develop chronic neuropathic and centralized pain. In fact, current evidence points to an age-dependent increase in the frequency of SCD patients with chronic pain. Management of disease-related pain should be based on its pathophysiologic mechanisms instead of using recommendations from other non-SCD pain syndromes. Pain management in vaso-occlusive crisis is complex and requires multiple interventions such as pharmacologic, nonpharmacologic, and preventive therapeutic interventions. Pharmacologic treatment involves the use of non-opioid and opioid analgesics, and adjuvants - either singly or in combination - depending on the severity of pain. The basic approach is to treat SCD pain symptomatically with escalating doses of non-opioid and opioid analgesics. Given the moderate-to-severe nature of the pain usually experienced in this form of SCD crisis, opioids form the bedrock of pharmacologic treatment. Multimodal analgesia and structured, individualized analgesic regimen appear more effective in achieving better treatment outcomes. Although the current evidence is still limited on the supportive role of cognitive behavioral therapy in pain management, this nonpharmacologic approach is reportedly effective, but needs further exploration as a possible adjunct in analgesia.

Perception of donor breast milk and determinants of its acceptability among mothers in a developing community: a cross-sectional multi-center study in south-east Nigeria.

BACKGROUND: Due to the health and economic benefits of breast milk, the World Health Organization (WHO) recommends that for infants who cannot receive breast milk from their own mothers, the next preferred option is donated breast milk. This recommendation is however rarely practiced in most developing countries where donor milk is not widely accepted. METHODS: This cross-sectional multi-center study enrolled mothers attending antenatal or pediatric clinics in six tertiary institution in south-east Nigeria using purposive and convenient sampling method. Data collection was done using pretested questionnaires. The study aimed to assess the knowledge, acceptability and willingness to donate breast milk and/or use donated breast milk for their infants It also explored factors that determine this behavior. RESULTS: A total of 1235 mothers participated; 39% (480/1225) have heard about the concept of donor milk, while only 10% (79/759) and 7% (81/1179), respectively, had adequate knowledge of the concept and policy on donor milk. Sixty percent indicated willingness to use donor milk or donate breast milk if need arises. Respondents with lower age (p = 0.049) and with higher occupational status (p = 0.001) were more likely to have adequate knowledge of donor breast milk, while respondents with lower educational attainment (p = 0.002) and those who are non-Christians (p = 0.004) were more likely to request financial inducement for donating their breast milk. Adequate knowledge of the concept of donor milk (p = 0.001), preference of donor milk to infant formula (p = 0.001) and requirement of financial remuneration (p = 0.001) were the only significant predictors of willingness to donate and/or receive donated breast milk. CONCLUSION: The knowledge of the concept of donor breast milk and awareness of policies regulating its practice in Nigeria is low, but the prospect of its acceptability is high among mothers surveyed in south-east Nigeria. Targeted public education by relevant government agencies in collaboration with clinicians, community and religious leaders about the concept of donor breast milk to families may help increase the acceptance and practice of donating breast milk and/or use of donated breast milk among mothers in the region.

Environmental risk factors for asthma in 13-14 year old African children.

Background Asthma prevalence in African children is high. Factors driving the prevalence or disease severity are poorly understood. This study aims to investigate environmental factors associated with asthma and severity in African children. Methods Population based cross-sectional study of children aged 13-14 years from 10 African centers who participated in ISAAC III. Self-reported environmental exposures included engaging in physical exercise, television watching, various biomass and ETS exposure, consumption of paracetamol, large family sizes and having pets in the home. Univariable and multivariable analyses were done adjusting for center variations. Prevalences, odds ratio and 95% confidence intervals (CI) were calculated. Results There were 258 267 children recruited among the 13-14-year-old participants. Of these, 28,391 respondents from 232 schools completed both the written questionnaire (WQ) and environmental questionnaire (EQ). The prevalence of asthma and severe asthma were 12.8% (CI 12.4-13.2), and 8.7% (CI 8.4-8.0) respectively. Factors strongly associated with asthma were maternal smoking (OR = 1.41; 95%CI: 1.23-1.64), open fire heating (OR = 1.28; 95%CI: 1.08-1.51) electric heating (OR = 1.13; 95%CI: 1.01-1.28), physical exercise (OR = 1.29; 95%CI: 1.11-1.50), monthly paracetamol use (OR 1.23; 95%CI 1.13-1.33), having an elder sibling (OR = 0.87; 95%CI 0.77-0.98). Factors associated with severe asthma were maternal smoking (OR = 1.61; 95%CI: 1.38-1.89), cat pet (OR = 1.14; 95%CI: 1.04-1.25), frequent physical exercise (OR = 1.42; 95%CI: 1.23-1.64) and monthly paracetamol use (OR = 1.20; 95%CI 1.07, 1.34). Conclusion Several environmental exposures were associated with asthma and severe disease.

Chronic kidney disease in children: Using novel biomarkers as predictors of disease.

Chronic kidney disease (CKD) in children contributes to the global health burden. The focus on using novel biomarkers to predict the onset and progression of the disease has increased tremendously over the past decade. Discovery of these biomarkers offers prospects for the early anticipation of the late stages of CKD, slowing down disease progression, and achieving better disease outcomes. The aim of this article is to classify and highlight the utility of these novel biomarkers in predicting disease-onset and progression. Biomarkers of CKD are broadly classified into biomarkers of kidney function and biomarkers of kidney damage. Glomerular filtration rate (GFR) remains the most important marker of kidney function, but it cannot be easily measured in most clinical and research settings. Its estimating equations, therefore, depend on filtration biomarkers such as serum creatinine and serum cystatin C. For instance, the CKD-epidemiology collaboration equation has been suggested as the preferred prediction equation for the staging and classification of estimated GFR (eGFR) in CKD. Although albuminuria is the traditional biomarker of kidney damage, it precedes any decline in eGFR and may be absent in tubulointerstitial disease. Thus, more sensitive and specific novel biomarkers of kidney damage are emerging which hold prospects for earlier prediction of CKD in children. They have been classified as tubular and miscellaneous biomarkers. Tubular biomarkers are represented by markers such as kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, N-acetyl-ß-D glucosaminidase, liver-type fatty-acid binding protein, cystatin C and a-1-microglobulin. Miscellaneous biomarkers include monocyte chemoattractant protein-1, interleukin-18, and retinol binding protein 4. Despite their advantages over albuminuria, they still require validation before they can be applied in clinical practice.

ABO histo-blood group and risk of respiratory atopy in children: a review of published evidence.

Besides their fundamental role in transfusion medicine, ABO and other histo-blood group antigens are associated with the pathogenesis of some human diseases such as malignancy and thrombosis. Reports also show a possible relationship with the risk of asthma and other forms of respiratory atopy. This paper aims to critically review the current evidence linking ABO histo-blood group with the risk of respiratory atopy in children and adults. A literature search was conducted with PubMed to gather baseline data about this relationship. The search extended to studies published within the past 45 years. First, the molecular mechanism underpinning the role of ABO antigenic system in human diseases comprises a fascinating relationship with von Willebrand factor and several pro-inflammatory and adhesion molecules. Second, specific blood group types vary with asthma phenotypes; severe asthma is associated with B phenotype, while mild and moderate asthma is associated with O and A phenotypes. Third, O phenotype has been linked to allergic rhinitis but only in males. Furthermore, asthma risk is related to O/Lewis negative/secretor phenotypes, while a significant relationship has also been established with B phenotype but not with A and O phenotypes. However, one study failed to establish a significant relationship with any of the ABO blood group antigens. In conclusion, there is no unanimity on the specific histo-blood groups linked to respiratory atopy risk, although asthma phenotypes are associated with specific blood groups. Despite the prospect that this relationship holds for the use of blood-group typing in evaluating respiratory atopy risk in children, more evidence-based studies are still required for its validation.

Prevalence and determinants of airflow limitation in urban and rural children exposed to cooking fuels in South-East Nigeria.

Background Biofuels and other cooking fuels are used in households in low- and middle-income countries. Aim To investigate the impact of cooking fuels on lung function in children in urban and rural households in South-East Nigeria. Methods The multi-stage sampling method was used to enroll children exposed to cooking fuel in the communities. Lung function values FEV1, FVC and the FEV1/FVC ratio, were measured with ndd EasyOneR spirometer. Airflow limitation was determined with FEV1/FVC Z-score values at -1.64 as the lower limit of normal (LLN5). The Global Lung Function Initiative 2012 software was used to calculate the lung function indices. Results The median age (range) of the 912 children enrolled was 10.6 years (6-18). Altogether, 468 (51.6%) children lived in rural areas. Seven hundred and thirty-seven (80.7%) were directly exposed to cooking fuels (418/737, 56.5% in rural areas). Wood and kerosene were the dominant fuels in rural and urban households. The respective mean Z-scores of the exposed children in rural and urban were zFEV1 -0.62, FVC -0.21, FEV1/FVC -0.83 and zFEV1 -0.57, zFVC -0.14, FEV1/FVC -0.75. Few (5.2%, 38/737) of the children had airflow limitation. Most of them (60.5%, 25/38) lived in the rural community; the lowest FEV1/FVC Z-scores were those of exposed to a combination of fuels. Conclusion Exposure to cooking fuels affects lung function in children with airway limitation in a small proportion, Control measures are advocated to reduce the morbidity related to cooking fuels exposure.

Severe bronchial asthma in children: a review of novel biomarkers used as predictors of the disease.

Severe asthma or therapy-resistant asthma in children is a heterogeneous disease that affects all age-groups. Given its heterogeneity, precision in diagnosis and treatment has become imperative, in order to achieve better outcomes. If one is thus able to identify specific patient phenotypes and endotypes using the appropriate biomarkers, it will assist in providing the patient with more personalized and appropriate treatment. However, there appears to be a huge diagnostic gap in severe asthma, as there is no single test yet that accurately determines disease phenotype. In this paper, we review the published literature on some of these biomarkers and their possible role in bridging this diagnostic gap. We also highlight the cellular and molecular mechanisms involved in severe asthma, in order to show the basis for the novel biomarkers. Some markers useful for monitoring therapy and assessing airway remodeling in the disease are also discussed. A review of the literature was conducted with PubMed to gather baseline data on the subject. The literature search extended to articles published within the last 40 years. Although biomarkers specific to different severe asthma phenotypes have been identified, progress in their utility remains slow, because of several disease mechanisms, the variation of biomarkers at different levels of inflammation, changes in relying on one test over time (eg, from sputum eosinophilia to blood eosinophilia), and the degree of invasive tests required to collect biomarkers, which limits their applicability in clinical settings. In conclusion, several biomarkers remain useful in recognizing various asthma phenotypes. However, due to disease heterogeneity, identification and utilization of ideal and defined biomarkers in severe asthma are still inconclusive. The development of novel serum/sputum-based biomarker panels with enhanced sensitivity and specificity may lead to prompt diagnosis of the disease in the future.